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Plan Management Navigator

Navigator provides analytics for health plan administration. It is intended to provide commentary and observations on the management of health plan expenses under the direct control of the management team. Topics addressed include the cost of administration in each functional area, drivers of administrative costs such as product mix and operational metrics, economics of scale and other important topics.

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Most recent Navigator:
Past editions:

  • March 2017: Resolving the Paradox of Scale Among Blue Cross Blue Shield Plans
  • February 2017: IPS Plans - Best in Class
  • January 2017: BCBS Plans - Best in Class
  • December 2016: Economies of Scale in Health Insurance - Revised
  • November 2016: Larger Health Plans - Indications of Scale
  • November 2016: Apples to Apples, or How We Eliminate Mix Distortions
  • October 2016: Medicaid Administrative Cost Trends First Cost Decline Since 2009 - Revised
  • September 2016: Medicare Advantage Plan Administrative Cost Trends: Declines, Mostly
  • July 2016: Independent / Provider - Sponsored Administrative Cost Trends: Cost Optimization Continues
  • June 2016: Blue Cross Blue Shield Administrative Cost Trends: Cost Optimization Continues
  • Late May 2016: Nine Takeways: An Early Look at 2015 Independent / Provider - Sponsored and Blue Cross Blue Shield Administrative Cost Trends
  • May 2016: How Medicaid and Medicare Make You Different
  • March 2016: Sherlock Benchmark Meeting Resolutions
  • February 2016: Comparing "Best-in-Class" Independent / Provider - Sponsored Plans Against Their Peers
  • January 2016: Comparing "Best-in-Class" Blue Cross Blue Shield Plans Against Their Peers
  • December 2015: How Important are Economies of Scale in Health Insurance Companies?
  • Late October 2015: Medicare Advantage Plans' Benchmarks Per Member Administrative Costs Declined, Overall and Account and Membership Administration
  • October 2015: Medicaid Administrative Cost Trends: The Full Impact of the Affordable Care Act
  • Late July 2015: Independent/Provider-Sponsored Administrative Cost Trends: The Full Impact of The Affordable Care Act
  • July 2015: Blue Cross Blue Shield Administrative Cost Trends: The Full Impact of The Affordable Care Act
  • Fourth Week of April 2015: Why Scale Effects are Modest for Medicaid Plans
  • Late April 2015: Considering Demographics When Measuring Employee Productivity
  • Mid-April 2015: How Does Medicaid Affect Commercial Administrative Costs?
  • Early April 2015: The ROI on Medical Management for Medicaid Plans
  • Late February 2015: How do Best-in-Class Blue Cross Blue Shield Plans Achieve it?
  • February 2015: How do Best-in-Class Health Plans Achieve it?
  • January 2015: Analysis from Sherlock Benchmarks: The Account and Membership Administration Cluster
  • November 2014: Analysis from Sherlock Benchmarks: Does Organization Type Drive Administrative Costs
  • Late October 2014: Medicare Plans: 2013 is the Baseline Year
  • October 2014: Medicaid Plans: 2013 is the Baseline Year
  • September 2014: Summary of Sherlock Scale Study for Health Plans: They Exist but Should not be Overstated
  • August 2014: Larger Health Plans and Economies of Scale
  • Late July 2014: Independent/Provider-Sponsored Benchmarks: 2013 is the Baseline Year<
  • July 2014: Blue Cross Blue Shield Benchmarks: 2013 Is the Baseline Year
  • May 2014:
  • - Measuring the Efficacy of Medical Management in Medicare and Medicaid
    - PULSE Refocused
    - Medicare and Medicaid Benchmark Universes Being Formed

  • April 2014:
  • - TPAs and ASO: The Growth of Self-Insurance
    - Forming TPA Benchmark Universe

  • March 2014:
  • - Decisions of Low Cost Independent / Provider - Sponsored Plans
    - Dashboard Summary
    - PULSE Refocused
    - Sherlock Benchmarking Universes

  • February 2014:
  • - Decisions of Low Cost Blue Cross and Blue Shield Plans
    - New Benchmark Universes Being Formed
    - New Applications of Sherlock Benchmarks

  • January 2014: A Metric for the Payoff of Medical Management
  • November 2013
  • - Measuring Performance Improvements of Long-Term Benchmarking Participants

  • Late October 2013
  • - Medicaid Plans’ Administrative Costs Decelerate in 2012

  • October 2013
  • - Lean Six Sigma and Sherlock Benchmarks
    - Health Plans Expect Premium Increase Acceleration: 9.6% in 2014, or 6.8% After Buydowns

  • September 2013
  • - Administrative Expense Growth For Medicare Plans Accelerate in 2012
    - Benchmarking, Simplified

  • August 2013: The Cost of Medicare STAR Ratings
  • Late July 2013: Independent/Provider-Sponsored Plans’ Administrative Costs Were 8.7% of Premiums in 2012
  • July 2013: Blue Cross Blue shield Plans’ Administrative Costs Were 8.9% of Premiums in 2012
  • May 2013: Estimating Administrative Costs’ Sensitivity to Group Size
  • April 2013: Could 72,000 Health Plan Employees Lose Their Jobs Under Health Care Reform?
  • March 2013: Sherlock Company Resources and Health Care Reform
  • January 2013: Decisions of Low Cost Independent / Provider - Sponsored Plans in 2011
  • December 2012: Decisions of Low Cost Blue Cross and Blue Shield Plans in 2011
  • November 2012: ACA and Cost Benchmarks For Three Emerging Markets
  • October 2012: Administrative Costs for Medicare Advantage Plans Soar in 2011
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